Healthcare Provider Details

I. General information

NPI: 1528869112
Provider Name (Legal Business Name): AWBREY LANAI GIBBY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 09/12/2026
Certification Date: 09/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 S WALDRON RD STE 107
FORT SMITH AR
72903-2568
US

IV. Provider business mailing address

1933 S STANTON
ROGERS AR
72758-8212
US

V. Phone/Fax

Practice location:
  • Phone: 479-226-3509
  • Fax:
Mailing address:
  • Phone: 479-340-3656
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: